title: Reducing delay in the diagnosis of pregnancy-associated breast cancer: how imaging can help us.
abstract: BACKGROUND
  The evaluation of breast symptoms during pregnancy or lactation can be challenging but prompt, appropriate assessment of symptoms may lead to earlier cancer detection.
  
  
  METHODS
  A review of breast imaging from 22 women with breast cancer during or within 1 year of pregnancy was undertaken as part of a large population-based study of gestational breast cancer. Consensus findings of three reads using the Breast Imaging Reporting and Data System lexicon were recorded.
  
  
  RESULTS
  The commonest presenting symptom was a lump. Diagnosis by percutaneous biopsy was made correctly in 21 of 23 lesions. Lesions were predominantly invasive ductal carcinoma (91%). One third had extensive associated ductal carcinoma in situ (DCIS). Ultrasound (US) was abnormal in all symptomatic patients. The most common sonographic finding was a solitary hypoechoic mass with irregular margins. 'Expanded stroma' with prominent ducts and architectural distortion was noted in three cases; all had extensive high-grade DCIS. In three women, bilateral breast US detected cancer in the asymptomatic breast. Mammography (performed in 86% of women) was abnormal in 74%, despite the presence of dense breast tissue in 47%. Widespread calcifications were visible in 26%, with detection of asymptomatic contra-lateral disease in one patient. MRI was performed in six patients. Background parenchymal enhancement did not impair lesion detection; however, overestimation of lesion size can occur.
  
  
  CONCLUSIONS
  Ultrasonography is recommended for the initial diagnosis of breast symptoms during pregnancy and lactation. A negative study should not delay direct fine needle aspiration of a palpable lesion. Mammography is indicated where initial assessment suggests malignancy. MRI may have a role in selected cases.
authors.affiliation: Royal Perth Hospital, Perth, Western Australia, Australia. donna.taylor@health.wa.gov.au
authors.forename: Donna
authors.initials: D
authors.lastname: Taylor
authors.forename: Joanne
authors.initials: J
authors.lastname: Lazberger
authors.forename: Angela
authors.initials: A
authors.lastname: Ives
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wylie
authors.forename: Christobel
authors.initials: C
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D016217:Ultrasonography, Mammary / Q000379:methods*; D014850:Waiting Lists